class: center, middle, inverse, title-slide .title[ # Food science and nutrition in the oral health curriculum ] .subtitle[ ## ADEE, Leuven ] .author[ ### Michael Crowe, BDentSc, PhD ] .date[ ### 10-09-24 ] --- # Session goals - nutrition in oral health (COP) - integration into the curriculum - curriculum outline, dietary assessment, competency - student feedback/research aspects - how to 'promote' nutrition and oral health? .pull-right[]  ??? INTRO- spend half my time in dental practice and half in DDUH,TCD teaching/research. 1st objective is inc interest/engagement and nutr activities and our COP nutrition is aiming to contribute to that MAIN focus for me- outline what we developed and integrated in DDUH Overview of what we did rather than discussing each aspect of course Tocuh on some areas of postgrad research as this and clinical aspects is what seems to get most interest/feedback from Students Teresa will focus on ----much more of the detail regarding content and clinical relevance we would love if u would scan this QR code and give us your opinion on nutrition content in your curric and if u would like to share your comments or experiences so that we can maximise the outout of the COP --- # Is nutrition education "necessary"? .pull-left[] .pull-right[] .pull-left[] .pull-right[] ??? Most dentists deal with the consequences of diet related disease every day but many of us receive very little formal training in nutrtion. Teresa will discuss this also by way of BG but essentially, diet and nutriton has probably never been as topical in terms of health and we dotn need to look far for reasons for educating students about the topic- from keeping them up to date with various issues such as UPF, does infant formula contain added sugars, can food be used as medicine or just generally beibng aware of what is a healthy diet for our patients ---  -- .pull-left[] -- .pull-right[] ??? This is from a blog by the excellent sports nutritionist as usual OH often the bridemaid so was it always so? Well,, started off well in the early 1900's --- - 1922: **I predict** that it will be but a short time...which will leave no room for doubt that the **most effective element** in any plan for **preventive dentistry relates to the character of the diet**. .small[(McCollum, E. V.)] -- - 2014:The importance of including nutrition in the training of health care professionals.. **remains a low priority** .small[(Kris-Etherton et al)] -- - 2017: Nutrition education for oral health professionals: **a must, yet still neglected**. .small[(Khan et al)] ??? the improtance of diet and nutriton in oral health has been recognised for a long time, but whle we seem to acknowledge that, we still struggle to get it established in dental programmes. predictions can fail- trump Blood theranos --- # Current requirements for undergraduate education? - Be competent at performing a **dietary analysis** - Be competent to **provide dietary counselling** and nutritional education relevant to oral health - Have knowledge of...**role of diet and nutrition** - Be competent at obtaining data...**dietary habits**   ??? While a lot of current requirements mention 'having knowledge of' or competence in apsects of nutrition many of these are aspirations in practical terms..Providing dietary advice without a core nutriton foundation is meanginless,,,if a student is unable to assess.. Dental council GED USA? UK recent doc safe dent At a bare minimum the requirements in Ireland for UG is to be competent at- ... COMPETENT-defintion - Most studies report that a lack of confidence, knowledge and training are the biggest barriers for dentists in practice wrt dietary advice and nutrition - I would argue that ther are other reasons -remuneration, lack of appreication of preventive based care (by all) --- # Who teaches nutrition and oral health .small[(and what are students taught?)]   - Few curriculum road maps/models - Faculty training nutrition? ??? favculty availablr raree-biochem, oral biol, - students should be able to discuss doiet and nutrition with patients as they do with flouride need applied nutrition skills- interviewing, counselling, behaviour change.... issues with eg physiol, biocehm, dent teaching -no nutr backg not many dieticians in denta; SO we need to invest, treain, develop adn be up to date! nutr labelling regulations, what is UPF?, how can give approp dit advice if dont undestand basic food and nutr concepts! --- .pull-right[] .pull-left[] ??? So with the help of several staff in DDUH, and the then dean Brian O'C, we had the opportunity to develop a nutriton programme -dieticians, nutritionists, dentists with interest in, etc Nutrition introduced (2020) -online - Dental science (2nd Yr) - Dental nurses and hygienists COVID video/blackboard,, zoome etc- videos great to go back on and pause v better in person- everyone learns differnetly Working group of interdiscipl- nutritionistsperio, prostho, behaviour change, to devise curric --- # Learning outcomes - impact of food science and nutrition on oral and general health - dietary guidelines and DRVs - dietary assessment and analysis - dietary intervention strategies. .pull-right[] ??? - Understand the impact of food science and nutrition on dental and general health. - Be familiar with dietary guidelines and dietary reference values. - Have the skill-set to perform dietary assessment and analysis. - Be able to make appropriate patient focused recommendations and employ dietary intervention strategies. --- # Course outline: Year 2 dental science  ??? comments on changes, students FB, overlap biochrem/pbl, split into yr 2 and 3 (more clinical) Have added another workshop to replace a saliva sensory pract- libro app --- # Dietary assessment - use digital tools! - patient compliance - digital literacy - education-behaviour change .pull-left[] .pull-right[] ??? pt compliance has always been an issue with diet assessm in dentistry increase compiance -use dig tools Students need more digital literacy Paper diary coloured v digital tools! ---  ??? is Irish, no affiliations to it, also used FB24 for research age, weight, hgt, gender, physical activity level, est nutrient requirements. Then food diet log Explain - conversion -log to food comp database (flow chart CRA-ADA plus diet assessment 24HR multiple nutritics ---   .pull-left[] .pull-left[] ??? mobile app-can send patient link we get students to do 24 HR with patients first ---  -- .pull-right[] ??? once you have completed the diet log you then can generate a nutrient report and this is the initial part of a sample one. On the top row you can see the source for DRVs is the EU;EFSA database, the estimated energy requirement is a calculate value and then the period of assessment and age, height and weight of the patienbt. YOu can see the energy intake and macrontrient profile here. The columns indicate the limits, actual intake and targets --- ## Nutrient profile  ---  ---  ---  ---  --- # Diet assessment competency- 3rd Year  .pull-right[] ??? workshop assignment yr 2 comp yr 3 --- # Assessment  ??? - Year 2: written SAQ, MCQ, assignment - Year 3: clinical competency 'Nutritics' and OSCE - Year 4: OSCE - Year 5: portfolio OSCE 3rd/4th year Nutritics: case-based diet assessment creation of case, diet log evaluation/interpretation report Portfolio 4th/5th years --- # Key nutrition messages for dental students - basic nutrition knowledge - use Dietary Reference Values/guidelines - perform effective dietary assessment - healthy diet for development and prevention - screen/educate/intervene/repeat ??? 1. Know how to carry out dietary risk assessment 2. Know the concepts and background for malnutrition and frailty 2. Understand how nutritional screening and assessment are carried out and the reasons for using them 3. Be able to adopt a rational, methodological approach to case-based diagnosis of nutritional problems Use food to supplement your diet (except Vit D, folic avid) Know that DRVs apply to the healthy pop! SUPPLEMENT Organic, free range, natural, ???! --- # Student feedback  - 88-95% positive responses: "importance", "interesting", "worth doing", "good evidence base". ??? - Good understanding of nutrition important for a dentist? (93%) - Course interesting and worth doing? (88%) - Good evidence base for nutrition in general and oral health? (95%) Student feedback? - 'I understand that I need to address dietary advice yet realistically speaking do I need to cover all concepts of nutrition for me to provide that?' - '..the course is duplicating material from PBL' - 'If Dr Crowe were to provide ONLY the relevant 3 lectures we would be spending that time on studying other content that is of more relevance' Have surveyed students for last 4 yrs, generally positive comments, but length of lectures is a consistent complaint, 45mins per lecture but double slot! ALso, because they have had mainly PBL for year 1 and 2 they struggle with traditional, videos- some like, most prefer in person One of issues with student FB is the variety of responses, "aplacewhereallthewomanaregood-look- ing, all the men are strong, and all the children are above average." --- # Re-evaluate and update content - applied nutrition - intervention/behaviour change - sustainability (SHD) - wider community/healthy lifestyles - student welfare ??? Opps- signific inc govt funding for food science and nutrition research programmes, eg behaviourla personalised nutrition with diet behaviour intervention (EU study) Sustainability is here- med realise it (paper) -we should be at forefront o fthat awareness- 30% GHGE derived from the food system- a HSD for good gen and oral health can have larger impact than eg cups.... combat pseudoscience and nutritiion calims-knowlegislation/labelling, science Refomuilation to reduce sugar- impact cariogenicity Snacking SPace nutrition-the future --- # Potential for nutrition-oral health 'interactions' .pull-left[] .pull-left[] .pull-left[] .pull-right[] ??? .pull-right[] we need to be more active to inteeract and promote the message of NB of nutriton in OH so take adv- techn-dashboard to dissemintate early findings eg use repositories such as zendoo/DMPonline/GIthub when starting research/sharing lectures Offer to devlop PILs for patient groups eg IF St James dieticians Collaborate Engage with dieticians/nutritionists _SII/UCD/ FHI/DAiry council/BBia/ --- # Postgraduates/research .pull-left[] .pull-left[] .pull-right[] .pull-right[]  .pull-right[] ??? https://www.openaire.eu/zenodo-guide - how to select 'best' diet assessment instrument - data analysis and digital tools-open repos to share, github, DMP - statistical modelling - learn some R/Python/Stata and use AI! OH surveys/diet asssess/ even categorical survs v eg nutrient est, still need to know how to quantify/analyse patters, reklations with OH outcomes --- # COP Nutrition activity - propose modifications to GED learning outcome's - nutrition teaching  ??? we have a COP committee but looking for input, opinons, contributions- delighted to meet anyone with suggestions etc. --- # Summary - can successfully integrate nutrition - dietary assessment skills important - clinical case scenarios - research opportunities with high-risk groups .pull-right[] ??? where poor OH obvious GOAL was to stimulate interest and activity in COP Nutrition - describe our experience in integrating into the curriculum - focus on curric. outline/dietary assessment/competence - evaluation/student feedback/research -They not only don’t know, they don’t know what they don’t know". No on model, LO's can vary but multidiscip development of content useful, need to continually update wrt guideliens, and technology (apps, video/online/interaction)- case based gets pos response! --- # Acknowledgements - Dublin Dental University Hospital, TCD - COP Nutrition, ADEE .pull-left[] .pull-right[] ??? Partic Tx to former and current for encouraging this BOC and Blathnaid daly, MBorthelo for encouragin COP Teresa marshall Domenico dallesandri Ruxandra --- # What nutrition resources-experiences do you have or need?  .pull-right[] ---